[Clinical and therapeutic particularities of depression in the elderly]

Depression in older people slightly differs from younger subjects adults. Generally, typical depressive symptoms are overlooked by other symptoms. The most frequent ones are excessive preoccupation with health and complaints about physical symptoms. Anxiety is a common accompaniment of depression in later life. Poor subjective memory or dementia-like and psychotic symptoms are also common in depression in the elderly. The exogenous depression, the most common forms of depression in elderly people, has a little response to antidepressants. The endogenous depression is associated with high risk of suicide. Depression in older people often coexists with physical disorders. The most frequently encountered is Parkinson's disease. Depression could also be one of the side effect of the use of drugs for physical illnesses. The Tricyclic antidepressants [TCAs] are generally too toxic for elderly people and should not be considered as drugs of first choice. Currently, the drugs of choice are the serotonin-selective reuptake inhibitors [SSRIs]. They have an antidepressant effect similar to that of [TCAs], but they are less toxic. The antidepressant treatment in the elderly is usually initiated at a low starting dose, ideally no more than half the usually recommended for the adults. For psychotic depression a combination of an antidepressant used in conjunction with antipsychotic drug is more effective than an antidepressant administered alone. The treatment should be continued for six months at least in order to reduce the risk of relapse. Moreover, long-term treatment is recommended because of the high risk of recurrence

[Sociocultural, clinical and psychological profile of the epileptic consulting in adult psychiatry, relative to 197 cases]

In the Sfax area and the south of Tunisia, epileptics are not all followed by neurologist. Some are addressed to psychiatrist. This fact raises the question of the motivations of such an orientation. The objectives of our survey were to point out the socio-cultural, clinical and psycho [patho] logical profile of the epileptic consulting in adult psychiatry, in Sfax teaching hospital, and to confront it to literature data coming from the studies dealing with the epileptic treated in neurological wards. It was a retrospective survey assesing the epileptic whose first consultation occurred from the 1st January 1999 to 31st December 2003. The studied sample included 197 cases. The sex-ratio [male/female] was 2.18. The rate of generalised seizures was 84.4%. The aetiology was known or presumed to be genetic in 48.2%. Sixty-nine per cent of the epileptics had mental disorders Our results and literature data showed that, compared with the epileptic treated in neurological wards, the consultants in psychiatry had epilepsy treated in a more classical way, more difficult to stabilise and frequently associated with mental disorders. By another way, we point out that in the area of our survey, although a department of neurology does exist, some epileptics without mental disorder are still addressed to psychiatrist, at least up to the period of the survey. Anyway, what seems to be more important is that the treatment should have realistic objectives. Psychotherapeutic support is fundamental to help epileptics to lead a decent life